无创颅内压监测在早期预警高血压脑出血后血肿扩大中的意义

Clinical study of noninvasive intracranial pressure early - warning hematoma enlargement in patients with hypertension intracerebral hemorrhage

目的探讨无创颅内压（NICP）监测在高血压脑出血（HICH）后血肿扩大早期预警中的作用及意义。方法应用NICP监测技术前瞻性地对158例HICH病例进行动态监护，经颅脑CT证实后分为血肿扩大（HE）组和血肿稳定（HS）组，并对两组NICP、脑灌注压（CPP）、血肿侧与健侧NICP的差值（D值）及预后进行对比分析。结果全组符合血肿扩大诊断59例（37．3％），其中91．5％的病例发生于起病12h以内；同时，HE组NICP及D值较入院首测均显著增高（P=0．001和0．000），而CPP以及Hs组NICP、CPP及D值则均与入院首测无显著改变（P〉0．05）；对D值≥1．3mm Hg的病例数分析，入院首测时两组间差异无统计学意义（P=0．873），而血肿扩大或24h后复测HE组为51例（86．4％），较Hs组的7例显著增多（P=0．000）；GOS评分HE组的良好率显著低于Hs组（P=0．000），而植物生存及病死率则显著增高（P=0．005和0．036），但两组中残及重残的发生率差异均无统计学意义（P=0．604和0．256）。结论NICP因其无创、可连续监测的优点可能成为早期预警HICH后血肿再扩大的有效监测手段；而以D值作为观察指标时，这种预警可更为早期和敏感。

Objective To evaluate the clinical significance of noninvasive intracranial pressure （NICP） monitoring of early - warning hematoma enlargement in patients with hypertension intracerebral hemorrhage （HICH）. Methods 158 cases with HICH Continuous monitoring NICP were divided into two groups comfirmedbased on brain CTs, the hematoma expanded （HE） group and the hematoma stable （HS） group. An analysis and comparison between the two groups were performed focusing on characteristics, such as the difference of NICPs between the hematoma side and the healthy side （D value） , NICPs, cerebral perfusion pressures （CPP） , and the Glasgow prognosis scores （GOS）. were analyzed and compared between the two groups. Results 59 patients in 158 cases had sustained hematoma increased （accounting for 37.3% ） ,of which 91.5% occurred within 12 h. NICP and D values in the HE group significantly increased from first detection, while there were no significant changes of CPP in the hE group. NICP, CPP, and D values in the HS group were similar to the first test （ P 〉 0. 05）. According to the cases counted on the D value ≥ 1.3 mmHg, there were no significant differences between the two groups at the first measuring （ P = 0. 873）. However, 51cases （86.4%） were met with the condition in the HE group after undone test, which is significantly higher than the HS group （ P = 0. 000）. The comparison of HE and HS groups＇ Glasgow prognosis score （GOS） showed that the good rate was significantly below （ P = 0. 000） , plant survival and mortality rates were significantly higher （ P = 0. 005 and 0. 036）, and there were no significant differences in mild disability and severe disability rates （ P = 0. 604 and 0. 256 ）. Conclusion NICP, characterized with non -invasive, simple operation, and continuous monitoring, may become an effective means of monitoring and detecting early warning hematoma enlargements in patients with HICH. When the Dvalue is regarded as observed indicators, this warning may come earlier and be more sensitive.